amphotericin-b and Stomach-Neoplasms

Surgical therapy of carcinoma of the esophagus or cardia by transthoracic esophageal resection is associated with a high morbidity in which nosocomial infections have a great importance. This study investigates the influence of prophylactic selective bowel decontamination on the course and results of transthoracic resection of the esophagus.. Seventy patients with carcinoma of the esophagus and cardia were included in this prospective and partially randomized study at the University of Heidelberg. Twenty-five patients received prophylactically selective bowel decontamination with tobramycin, polymyxin B and amphotericin B. The treatment course was documented uniformly. In addition, microbiological screening was performed by swab examinations of nose, throat and anus, by urine and blood cultures, and the documentation of results of additional microbiological diagnostic studies.. Bacteriological screening confirmed a reduction in infectious agents and a change of their spectrum in the respiratory and digestive tract without an increase in multiresistant bacteria. Patients who received selective bowel decontamination had a lower infection rate, a shorter artificial respiration period and a shorter intensive care stay without statistically significant differences. The mortality rate was 4% vs 9% in the control group (95% confidence interval -0.172-0.116).. This study confirms the feasibility and microbiological effectiveness of selective bowel decontamination in the context of surgical therapy which is associated with a high nosocomial infection rate. The result of the clinical treatment seems slightly more favorable in the treatment group. Decisive are complications caused by surgery which fundamentally determine the clinical course and frequently cause infectious complications. The prophylactic use of selective bowel decontamination may be useful in patients with an increased risk of prolonged ventilation support or colon interposition but it is not to be generally recommended.

Topics: Aged; Amphotericin B; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteria; Cardia; Cross Infection; Esophageal Neoplasms; Female; Humans; Intestines; Male; Middle Aged; Polymyxin B; Prognosis; Prospective Studies; Respiration, Artificial; Risk Factors; Stomach Neoplasms; Tobramycin

The aim of this study was to examine the effect of decontamination as compared to placebo medication on post-gastrectomy treatment costs. The results of a prospective double-blind placebo-controlled multicenter trial indicate that perioperative i.v. prophylaxis with cefotaxim and topical decontamination with polymyxin B, tobramycin, vancomycin and amphotericin B from the day before surgery until the 7th postoperative day is most effective in the prevention of esophagojejunal anastomotic leakage following total gastrectomy. For the cost analysis, only patients who had been decontaminated according to the study protocol (n = 90) were compared to the non-decontaminated patients (n = 103). The esophagojejunal leakage rate was 10.6% in placebo patients (n = 103) and could be reduced significantly to 1.1% in decontaminated patients (n = 90, P = 0.0061; two-tailed Fisher's exact test). There was only one asymptomatic leakage detected on Gastrografin swallow. The pulmonary infection (P = 0.0173) and overall complication rates (p = 0.0238) were significantly reduced in the decontamination group as well. During the observation period, 9 (8.7%) patients in the placebo group and 3 (3.3%) in the decontaminated group died (P = n.s.). Patients were followed up for the initial 42 postoperative days and treatment costs were calculated for this time period only. The parameters compiled in the study pertaining to use of medical resources formed the basis for the determination of the postoperative treatment costs. These were the costs for decontaminating drugs, intravenous antibiotics, reoperations and non-surgical reinterventions as well as daily treatment costs of the general ward, the intensive care unit (ICU) and rehabilitation. The average costs per patient in the placebo group amounted to DM 20,000 while the costs for decontaminated patients were only DM 16,200, which was due to a significantly lower number of patients requiring treatment in the ICU (P = 0.0082), significantly fewer patients requiring i.v. antibiotics (P = 0.0232) and fewer patients with reoperations (P = 0.0909). The prophylaxis employing decontaminating drugs in the amount of DM 400 lowered post-gastrectomy treatment costs by DM 3800 or 19%. The prophylaxis can be recommended, because it lowers morbidity, mortality and the costs of total gastrectomy.

Topics: Aged; Amphotericin B; Antibiotic Prophylaxis; Cefotaxime; Cost Savings; Double-Blind Method; Drug Therapy, Combination; Female; Gastrectomy; Humans; Male; Middle Aged; Polymyxin B; Prospective Studies; Stomach Neoplasms; Surgical Wound Dehiscence; Surgical Wound Infection; Survival Rate; Tobramycin; Vancomycin

We report the first case of fungemia due to Candida catenulata, a contaminant of dairy products. C. catenulata was isolated from three blood cultures of a patient with gastric cancer. The patient failed to respond to fluconazole but recovered after treatment was switched to amphotericin B. In vitro, C. catenulata was susceptible to amphotericin B and itraconazole and was also susceptible to fluconazole in dose-dependent manner. The likely portal of entry was the digestive tract, as the patient often ate cheese and had multiple gastric ulcerations.

Topics: Adult; Amphotericin B; Antifungal Agents; Blood; Candida; Candidiasis; Female; Fungemia; Humans; Stomach Neoplasms

The sensitivity to actinomycin-D (Act-D) and the changes in survival rate of two human choriocarcinoma cell lines (BeWo and SCH) were studied in vitro and the following results were obtained. BeWo was shown to be more sensitive to Act-D than SCH, when the survival rate was compared in the two cell lines. 3H X Act-D uptake was 39 pmol/10(6) cells in BeWo and 12 pmol/10(6) cells in SCH after a two hours treatment. Those results suggested that the sensitivity to Act-D of choriocarcinoma cells was positively correlated with the intracellular Act-D concentration. The intracellular Act-D concentration was increased depending upon the concentrations of amphotericin B (AMB). After a two hours treatment with Act-D and AMB, the intracellular Act-D concentrations were twice in BeWo, and 2.3 times in SCH comparing with those treated with Act-D alone. The synergistic effects of Act-D and AMB on the survival rate were 1,000 times in BeWo and 100 times in SCH compared with those treated with Act-D alone. From the above, combination therapy with Act-D and AMB was supposed to be one of the trial methods in the treatment of drug resistant choriocarcinoma.

Topics: Amphotericin B; Cell Line; Cell Survival; Choriocarcinoma; Colony-Forming Units Assay; Dactinomycin; Drug Evaluation, Preclinical; Drug Synergism; Humans; Male; Stomach Neoplasms; Tumor Stem Cell Assay

Amphotericin B (AmB)-5-fluorouracil (5-FU) combination therapy against cancer was evaluated when both were given orally. Seven gastric cancer patients were treated in this manner, and 4 gastric cancer patients treated with 5-FU alone to serve as the control. AmB syrup and 5-FU syrup were administered orally for 3 days before surgical operation. Then, the drugs were given through a gastric tube into the stomach 4 hr before the start of the gastric surgery. Lesion tissues and healthy tissues were collected from each patient and the 5-FU titers were measured by bioassay. It was shown in the majority of the gastric cancer cases that the 5-FU levels in the lesion tissues were substantially higher than those in the surrounding normal tissues, whereas in the gastric cancer patients who received 5-FU alone, most of the lesion tissues showed lower 5-FU content as compared with that of the surrounding tissues.

Topics: Administration, Oral; Aged; Amphotericin B; Drug Therapy, Combination; Female; Fluorouracil; Humans; Male; Middle Aged; Stomach Neoplasms

AmB/NCS combination therapy against cancer was evaluated. Six gastric cancer patients were treated in this manner, and 7 gastric cancer patients treated with NCS alone to serve as the control. AmB sirup was administered orally for 4 days before surgical operation. NCS was given intraveously at the onset of gastric surgery. Lesion tissues and healthy tissues were collected from each patient and the NCS titers were measured by bioassay. It was shown in the majority of the gastric cancer cases that the NCS levels in the lesion tissues were substantially higher than in the surrounding normal tissues, whereas in the gastric cancer patients who received NCS alone, no significant differences were found between the tissues.

Topics: Adult; Aged; Amphotericin B; Antibiotics, Antineoplastic; Biological Assay; Drug Synergism; Female; Humans; Male; Middle Aged; Stomach Neoplasms; Zinostatin

AmB/NCS combination therapy against cancer was evaluated. Seven gastric cancer and 2 gastric polyp cases were treated in this manner and in addition 2 gastric cancer patients were treated with NCS alone, to serve as the control. AmB dissolved in glucose solution was administered intravenously as was NCS, which was given at the onset of gastric surgery. Lesion tissues and healthy tissues were collected from each patient and the NCS titers measured by bioassay. It was shown in the majority of the gastric cancer cases that the NCS levels in the lesion tissues were substantially higher than in the surrounding normal tissues, whereas in the gastric polyp and the gastric cancer patients who received NCS alone, no significant differences were found between the tissues.

Topics: Adult; Aged; Amphotericin B; Antibiotics, Antineoplastic; Female; Gastric Mucosa; Humans; Male; Middle Aged; Polyps; Stomach Neoplasms; Zinostatin

Topics: Aged; Amphotericin B; Biopsy; Diagnosis, Differential; Gastrectomy; Gastric Juice; Gastric Lavage; Gastric Mucosa; Humans; Male; Mucor; Mucormycosis; Stomach Diseases; Stomach Neoplasms; Stomach Ulcer

Topics: Aged; Amphotericin B; Biopsy; Diagnosis, Differential; Histoplasmosis; Humans; Intestine, Small; Male; Radiography; Stomach Diseases; Stomach Neoplasms